This is a proposal for a midcareer investigator award in patient-oriented research. This career development award will give Dr. Corbie-Smith the dedicated time to focus on patient-oriented research in cardiovascular disease prevention, and recruit and mentor some of the brightest young scientists at UNC into healthcare disparities research. Her immediate career objectives are: 1) To extend her work in engaging communities of color in research by developing interventions to prevent cardiovascular disease that address patients in the context of their communities; 2) To understand the influence of community factors in underserved communities and their impact on healthcare utilization and health outcomes in cardiovascular disease and cardiovascular risk factors; and 3) To provide outstanding mentorship by creating a training environment that supports the conduct of high impact research in cardiovascular prevention and outcomes. The specific aims for the new research to be supported through this K24 Midcareer Investigator award include 1) Determine the feasibility of training a current cohort of community health advisors as navigators to link residents with multiple cardiovascular risk factors to local healthcare systems; 2) Determine the impact of navigators on cardiovascular risk factor control (HgbA1C, physical activity, BP control, smoking) and access to care for community members at increased risk for cardiovascular disease; 3) Identify community and social factors that influence cardiovascular risk factor control and outcomes. This two-arm trial will investigate the role of navigators on cardiovascular outcomes in community based outreach programs to improve access and utilization of medical services. Two to three navigators at each of the four sites will be utilized. Patients will be randomized to either a navigator intervention or to usual patient management practices, with measurement at baseline and six months. This study targets a disease condition and population of significant importance - CVD risk factor prevention in rural African Americans - and extends an existing effective model in several important ways. This study situates the navigator and patient within the community (rather than the healthcare system) thus increasing the cultural relevance of the intervention. Rather than a focus on one condition, navigators will support access and management of several chronic conditions, thus addressing the reality of multiple co-morbidities in underserved patients. Lastly, augmenting patient data with community variables allows a comprehensive analysis of external influence on cardiovascular disease prevention and healthcare utilization. PUBLIC HEALTH RELEVANCE: The proposed research will advance public health by testing a patient navigator program to improve access to and quality of care for those with heart disease risk factors. The mentoring component will train new researchers to conduct high impact heart disease prevention research.